How do Lung nodules form from RA?
Thanks Peggy for asking this question! I was curious myself as to if RA could affect our lungs, and how. I figured I'd make this blog on RA in the lungs, and all the complications it could possibly cause, not just nodules. I read that although RA primarily affects our joints, it can also affect our lungs. There are four common complications to lungs, due to RA. They include:
- Painful breathing. Rheumatoid arthritis can cause inflammation of the lining of the lungs (pleurisy). The inflammation can cause sharp pain while breathing.
- Shortness of breath. Fluid due to inflammation of the lining of the lungs may accumulate around the lungs (pleural effusion). This accumulation can cause shortness of breath.
- Lung nodules. Small lumps may form in the lungs (rheumatoid nodules), as well as in other parts of the body. Lung nodules usually cause no signs or symptoms, and they don't pose a risk of lung cancer. In some cases, however, a nodule can rupture and cause a collapsed lung.
- Scarring of the lungs. Rheumatoid arthritis can lead to scarring within the lungs. Signs and symptoms may include shortness of breath, chronic dry cough, fatigue, weakness and loss of appetite.
Now let's take a look at each complication. In the last blog I wrote about rib pain and RA and I explained pleurisy, so instead of repeating myself, I will skip that one. If you'd like to read more about pleurisy, please look back at the previous blog "Can you get RA in your Ribs?!" It includes an email from my Rheumatologist explaining this very question, and information about pleurisy as well as Costochondritis.
-Hamartomas (the abnormal formation of normal tissue is the most common – 75% of benign nodule cases).
-Bacterial infections (Tuberculosis, round pneumonia, atypical mycobacteria).
-Fungal infection (coccidioidomycosis known as Valley fever, histoplasmosis known as darling’s disease)
-Anthracosilicosis (Accumulation of carbon and silica in the lungs from inhaled coal dust)
-Fibrosing alveolitis ( a chronic, progressive form of lung disease characterized by fibrosis of the supporting framework (interstitium) of the lungs)
-Bronchogenic cysts (rare) (Bronchogenic cysts are small, solitary cysts or sinuses, most typically located in the region of the suprasternal notch or over the manubrium)
-Hemangiomas of the lung (benign tumour)
-Lymph node hyperplasia (Known as Castleman’s disease - rare benign tumour)
-Wegener’s granulomatosis (rare)
-Parasitic infection (prevalent in temperate, tropical and subtropical regions of the world)
Since this is an RA blog, and it's the question that Peggy asked, let's take a further look into how RA can cause lung nodules. Roughly one percent of RA patients show signs of pulmonary rheumatoid nodules in conventional X-rays, according to the Johns Hopkins Arthritis Center. However, high resolution computed tomography (CT) scans reveal signs of nodules in roughly 22 to 28 percent of patients. Rheumatoid lung nodules appear most frequently in men with active RA who also have high blood levels of the autoimmune antibody called rheumatoid factor, Johns Hopkins reports. Women and individuals with low blood levels of rheumatoid factor may also be affected. Smoking may be a risk factor for these nodules. Typically, rheumatoid lung nodules do not cause symptoms and do not develop into lung cancer, the Mayo Clinic reports. Potential complications include erosion of a nodule through the lung, infection and pneumothorax (collapsed lung). Additional potential effects of rheumatoid lung disease include pulmonary fibrosis (lung scarring), pulmonary hypertension (localized high blood pressure) and pleural effusion (fluid buildup inside the chest). Nodules are usually found in patients who have been suffering from RA for quite some time. Cigarette smoking in patients who have RA increases the chance that nodules will form. Methotrexate, a medication used to manage the symptoms of RA, has been found to increase chances that nodules will form.
In the future, I plan on writing a blog all about RA nodules, because that can form anywhere on the body. It seems that RA can affect just about anything. If you are having any complications with your lungs, please be sure to tell your Rheumatologist in case there is something going on. Never be afraid to tell your doctor of any symptoms you are experiencing, even if you think it's something small.